Traveling for Major Medical Care at Someone Else’s Expense: Is This the Future?


Dear Readers,

You’ve heard of folks flying to India or Mexico or some other farflung place to have surgery and save a bundle. Yet when they leave the borders of the good old U.S. of A, they also shed all the safety systems and the legal protections that patients here take for granted if malpractice happens.

Now there’s a new option: the medical vacation, without leaving home (or at least the U.S.).  Yes, there’s a chance you can have it all: gourmet food, ocean views, and surgery in a respected American hospital. And more: save money. And still more: equal or better statistical outcomes to your hometown hospital.

The catch: Only a few big employers are venturing into this new style of health care. But if it catches on, this could be for you too. Here’s a newsletter on how it works.

How the Medical Vacation Came to Be

Some businesses are applying the notion of “economy of scale” to surgery for their employees who need it. Instead of local hospitals, workers are sent to those around the U.S. with proven records of quality and success that have arranged with the company to provide reasonable, fixed rates for given procedures. The hospitals get a steady stream of business, and the employers get high-quality care for their employees at fixed, known costs.

For patients, as reported in the Los Angeles Times, the arrangement can be more like a vacation than a medical procedure, with all expenses paid for the patient and a companion, including air fare and sometimes even spending money.

One Nevada couple profiled in the story flew to California’s tony Newport Beach. The wife needed a hip replacement; after the procedure, the husband’s company put them up for a week in an oceanfront resort. The whole thing was covered fully.

If she had had the hip surgery closer to her home, she told The Times, “I would have been out $8,000 or $9,000 easy on my insurance.”

Today, she’s pain-free and extremely happy with the outcome. “This is like the honeymoon we never had,” she said.

That might be overstating things a bit; after all, who wants to spend their honeymoon doing physical therapy, even if you get to do it in a luxe hotel? Still, going far away to feel far better can make sense.

According to The Times, the grocery store chain Kroger has sent nearly two dozen employees to the prestigious Hoag Orthopedic Institute in Orange County, Calif., for hip, knee and spinal-fusion surgeries. Wal-Mart has plans to offer employees and their dependents no-cost heart, spine and transplant surgeries at six different hospitals across the country, all expenses included.

At Hoag, patients generally spend one or two nights in the hospital, then return to their hotel for follow-up care, including visits by their surgeons.

Kroger employees who choose one of the 19 hospitals with which the company has a deal might pay 10 percent out of pocket; if they choose a medical center closer to home that doesn’t contract with the company, they might pay as much as 50 percent.

According to The Times, of the 21 Kroger patients who have traveled for surgery this year, none has experienced complications or has been readmitted to the hospital, according to a company spokeswoman, who also said the cost of knee and hip replacement surgeries was 15 percent less than what Kroger pays at other hospitals.

Who Pays?

Consumers are often surprised when presented with a medical bill after the fact (See my newsletter, “The Unknowable Cost of Medical Care.“) Many suffer financial hardship as a result of these unwelcome surprises.

Businesses are no different; knowing the cost in advance of a variety of procedures is simply smart management. The cost savings for some businesses is so significant that they offer incentives to employees in the form of waived deductibles or cash bonuses.

As The Times reports, “Bundled deals are common for phone service, cable TV and travel. But an all-in-one price marks a radical departure for the conventional fee-for-service medical industry in which doctors, hospitals, labs and other providers typically bill separately for each part of a procedure. Then they tack on even more if complications and unexpected costs arise.”

Even the government is looking at all-inclusive pricing for common procedures for Medicare and Medicaid beneficiaries. They would be voluntary, but also cost patients less than local care.

Not Everyone Qualifies

Traveling for surgery isn’t right for everybody: You don’t qualify unless your insurance coverage is through your employer, and the business has contracted with specific medical centers for, in the vernacular, the “fleet” rate.

When you’re unwell, of course, the last thing you feel like doing is to travel. Some people are just too sick to withstand the stress. And some consumer advocates, as The Times notes, aren’t keen on patients traveling for treatment away from the doctors who know them and their condition, and may be responsible for follow-up care once the patients return home.

One surgeon at Hoag Orthopedic Institute who supports bundled payments told The Times that he’s careful to review potential patients traveling under the company plan. He won’t treat people who are at higher risk of complications from surgery. Such problems not only affect the patient’s welfare and ability to heal, but, as always, add to the cost.

How to Be a Smart Surgical Traveler

If your company offers surgical travel benefits, make sure the facility you choose has your complete health record, and that your regular doctors are familiar with the process and are willing and able to provide follow-up care, if necessary.

Find out from your company’s benefits department what medical provider is responsible if continuing care is necessary, and who is responsible-you or the company-for the cost.

Ask if there’s a warranty that explicitly describes what complications the medical providers are responsible for. As The Times noted, medical studies show that complications can cost $7,600 per patient.

If your company does not have a surgical bundling plan and you’d like it to investigate such a benefit, contact your human resources and/or benefits department. One resource mentioned in the L.A. Times story is BridgeHealth Medical Inc., a surgery benefits management company that helps employers, insurers and patients with “surgery shopping.” It has deals in place with about 45 U.S. hospitals.


To your continued health!

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Patrick Malone
Patrick Malone & Associates